For centuries, compression therapy has been utilized to treat venous disease. To date it remains the mainstay of therapy, particularly in more severe forms such as venous ulceration. In addition to mechanisms of benefit, we discuss the evidence behind compression therapy, particularly hosiery, in various forms of venous disease of the lower extremities. We review compression data for stand-alone therapy, post-intervention, as DVT prevention, post-thrombotic syndrome and venous ulcer disease. We also review the data comparing compression modalities as well as the use of compression in mixed arteriovenous disease.

The use of epinephrine during cardiac arrest has been advocated for decades and forms an integral part of the published guidelines. Its efficacy is supported by animal data, but human trial evidence is lacking. This is partly attributable to disparities in trial methodology. Epinephrine’s pharmacologic and physiologic effects include an increase in coronary perfusion pressure that is key to successful resuscitation. One possible explanation for the lack of epinephrine’s demonstrated efficacy in human trials of out-of-hospital cardiac arrest is the delay in its administration. A potential solution may be intraosseus epinephrine, which can be administered quicker. More importantly, it is the quality of the basic life support, early and uninterrupted chest compressions, early defibrillation and postresuscitation care that will provide the best chance of neurologically intact survival.

Chronic venous disease is a common disease, the prevalence of which increases with age, and can cause debilitating symptoms that adversely affect the quality of life. The risk factors include family history, female sex, obesity, pregnancy, parity, and history of deep vein thrombosis. Moreover, it is associated with venous obstruction, reflux, or both, which, in turn, leads to ambulatory venous hypertension. Chronic venous disease is the leading cause of leg ulcers, which place a significant cost burden on the health care system. Compression therapy remains the cornerstone of treatment, particularly for more advanced disease. Superficial saphenous vein reflux can be associated with significant symptoms. Catheter techniques, both thermal and nonthermal, have demonstrated efficacy and safety in successful closure and symptom improvement. Deep vein obstruction can be broadly divided into thrombotic and nonthrombotic and can lead to symptomatic chronic venous disease. Recanalization using balloons and stents has been increasingly used and studied in such patients. It is critical to develop training opportunities and guidelines to improve evidence-based and appropriate care for cardiologists treating chronic venous disease.

Venous disease is more common than peripheral arterial disease. Pathophysiologically, venous disease can be associated with obstruction, reflux, or both. A common feature in chronic venous disease is ambulatory venous hypertension. Inflammatory and pro-thrombotic mechanisms can be activated. The current therapies, including compression, ablation, and recanalization are discussed.

Chronic venous disease (CVD) is a common vascular condition that can have debilitating effects on quality of life and daily function. The Society for Cardiovascular Angiography & Interventions (SCAI) sought to develop evidence-based guidelines to support patients, clinicians, and other stakeholders in their treatment decisions about management of CVD. SCAI convened a balanced multidisciplinary guideline panel to minimize potential bias from conflicts of interest. The Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for the development of the guidelines. The guideline panel formulated and prioritized clinical questions following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in population, intervention, comparison, outcome format. A technical review team of clinical and methodological experts conducted systematic reviews of the published evidence, synthesized data, and graded the certainty of the evidence across outcomes. The guideline panel then reconvened to develop recommendations and supporting remarks informed by the results of the technical review, as well as additional contextual factors described in the GRADE evidence-to-decision framework. The guideline panel reached consensus on 9 recommendations to address variations in treatment of CVD across 8 different clinical scenarios. The panel also identified 4 anatomical scenarios with significant knowledge gaps. Key recommendations address patient selection for compression therapy, ablation of saphenous and perforator veins, sclerotherapy, phlebectomy, and deep vein revascularization. Two algorithms for the management of symptomatic varicose veins and venous ulcer disease were created to facilitate implementation of these evidence-based recommendations. The panel also identified several anatomical and clinical areas where future research is needed to advance the CVD field.